Varicose Veins: I’m In Good Shape, What’s Going On? Why Do I See Bulging Veins In My Legs?
An Explanation From Dr. Steven Elias
“I don’t understand”. “I eat right and exercise”. “Am I doing something wrong?” “Is training making it worse?” These are the many questions that athletes ask when they see visible bulging veins on their legs. They don’t understand why. They’re in good shape. They eat right. They take care of themselves. So why me? It’s mostly your parent’s fault (this is something you can blame them for).
If one parent has vein disease you have about a 33% chance of developing vein problems. Both parents, a 90% chance. Other risk factors include: pregnancy, obesity, increasing age, and hormone replacement. Exercise neither prevents nor causes vein problems, so keep it up. However, it does have some influence on symptoms. I will explain later. First let’s understand what veins do and what happens when they stop doing what they are supposed to do.
As we learned in high school biology, veins bring the blood back to the heart. It really has nothing to do with heart disease; it is the direction of blood flow (back to the heart from the legs) that is important. When we walk, our muscles pump the blood back to the heart against gravity. In our leg veins there are one-way valves (check valves) that open to allow blood flow upwards but close when gravity wants to pull the blood back down. The flow is supposed to be only one way (upwards). When veins are not working properly, blood does go up, but some leaks back down to pool and put pressure on our lower legs. This results in unsightly veins, symptoms and complications.
For athletes and others vein disease can be a cosmetic or symptomatic issue. Many times it is a combination of both. Only in extreme cases will vein problems hinder performance. Many athletes say their legs feel great when training but about 30-45minutes after training session the leg with varicose veins (bulging veins) aches, throbs, or feels more tired than the normal leg. If they elevate their legs things feel better. Now that you understand vein function you can understand why training your muscles are contracting and directing the blood up your veins in the direction of the heart. This includes the abnormal veins as well. During exercise your muscles have required more oxygen, so more blood came down your leg through your arteries. That extra blood needs to be brought back up the leg by your veins. If the veins are not working properly, some blood goes up but a lot stays down in your lower leg. This leads to the feeling of aching, throbbing, heaviness and tiredness. These are worse when you are standing around after a training session; your calf muscle pump is not working. Elevating your leg makes you feel better; gravity helps to drain the blood out of your leg. The positives and negatives of exercise cancel each other, so keep training. Cosmetically similar things happen only symptoms don’t develop. “Will they get worse?” “Can I just live with them?” “Are they a risk to my health?” “What can I do to stop them from getting worse?” “Will I develop blood clots?” ”What types of treatments are available?” “How soon after treatment can I exercise?” These are all very common concerns and rightly so.
“Will they get worse?” Yes and no. They will never get better but they may stay the same. However, as stated before, increasing age is a risk factor. You have a better chance that they will get worse. Add the other risk factors such as pregnancy or hormone replacement and chances increase. Let us assume if you are an athlete that obesity is one risk factor you need not worry about. In summary, as you get older they have a better chance of progressing.
“Can’t I just live with them?” The short answer is yes. If you do not mind how they look or feel then you can certainly live with them. No studies have shown that treating varicose veins before they bother you will prevent something in the future. Some physicians may tell patients “you better do something now.” There really is no hard data to support such advice. Having said this, there are good reasons to treat vein problems: if you don’t like how they look, if you don’t like how they feel or if you have had a complication. Complications can include phlebitis (inflammation of veins), bleeding, blood clots or ankle ulcers. Usually the decision to treat is yours, however with a history of complications I would urge you to have treatment.
“Are they a risk to my health?” As above, only when complications occur. Some of these problems may lead to infection, or life threatening blood clots. Bleeding from a varicose vein while dramatic and scary is not usually a life-threatening problem.
“What can I do to stop them from getting worse?” The only thing to do is to minimize the risk factors that increase progression. Obesity, pregnancy, and hormone replacement are the most common. Since family history is key, one can only minimize the risk factors you can control. The above are some of the reasons why vein disease is more common in woman (35-40%) than men (20-25%).
“What types of treatments are available?” All treatments available today are minimally invasive. The traditional “stripping” should only be performed in very selective situations. Patients should seek out vein specialists that offer modern minimally invasive vein procedures. These procedures are all same day, outpatient techniques that take under an hour. Most involve local anesthesia and usually either no incisions (just a needle stick) or a few 3 millimeter incisions. Patients can walk the day of the procedure and return to normal activity including exercise and training in a few days.
A variety of treatments are now available: sclerotherapy (chemical), EVLT (laser), VNUS Closure (radiofrequency) or TriVex (type of vein liposuction). Patients should see vein specialists that offer these advanced minimally invasive procedures.
In summary, athletic, active people no matter what age want a problem fixed with the least disturbance of their exercise or training. The days of incisions, weeks of rest and significant discomfort are now gone. Athletes who have been told by physicians, “Just live with your vein problem” or “Just wear support stockings” now have the availiability of very effective minimally invasive solutions. They can get back to exercise and training in just a few days. If you have vein disease seek out a vein specialist (phlebologist) and at least investigate your options.
Steve Elias is the Director of The Centers for Vein Disease at Columbia University Medical Center and Englewood Hospital and Medical Center, NJ. He is an Associate Professor of Clinical Surgery at the Columbia University Medical Center, NY. More importantly, he trains daily and has participated in triathlons.
Dr. Steven Elias lectures, publishes, and teaches extensively about minimally invasive vein care and procedures. As Course Director of the Annual Vascular Fellows Course in Venous Disease, he trains young vascular surgeons in the treatment of vein problems. His clinical interests encompass all aspects of vein care: spider veins, varicose veins, perforator and deep venous incompetence, and venous ulcers. He performs all minimally invasive vein procedures and his work at the Center for Vein Disease includes the prevention and treatment of DVT Deep Venous Thrombosis. Dr. Elias is a fellowship-trained vascular surgeon and member of the American Venous Forum, the American College of Phlebology, the Society for Clinical Vascular Surgery, and the International Society of Cardiovascular Surgery. He is a recipient of the Dardik Research and Education Award.
You can learn more about him and to view his most recent television appearance on NJ 12 log on to: www.pranamarketing.com/client/doctorelias.